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NPI Code Detail

MEDICARE: DR. MATTHEW H MANEELY DDS

MEDICARE: DR. MATTHEW H MANEELY DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5590-015WI
21223G0001XGeneral Practice Dentistry8008AZ

General Provider Information

NPI Number : 1669496824
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW H MANEELY DDS
Provider Business Mailing Address
First Line : 7006 S CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-5423
Country : US
Telephone Number : 602-276-1029
Fax Number :
Provider Business Practice Location Address
First Line : 7006 S CENTRAL AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-5423
Country : US
Telephone Number : 602-276-1029
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 12/12/2013

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